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Friday, March 23, 2007

RP vs. LRP vs. RLRP - Part 2. Laparascopic Surgery (LRP)

[Updated links March 19, 2008]

This is part 2 of a 4 part series comparing Open Surgery (RP),
Laparascopic Surgery (LRP) and Robotic Laparascopic Surgery (RLRP).

RP vs. LRP vs. RLRP - Part 1. Open Surgery (RP)
RP vs. LRP vs. RLRP - Part 2. Laparascopic Surgery (LRP)
RP vs. LRP vs. RLRP - Part 3. Robotic Surgery (RLRP)
RP vs. LRP vs. RLRP - Part 4. What Surgeons and Others Say


Advantages of laparascopic

Laparascopic surgery is discussed in Hasan & Gill 2004 review and on the web site of laparascopic surgeon, Dr. Arnon Krongrad. Krongrad's site includes pages on common questions [1] [2] [3] and a surgical manual. WebSurg.com has even greater detail on anatomy and the detailed steps involved in laparascopic surgery.

Advantages of laparascopic prostatectomy (vs. open) are:


  1. Reduced blood loss:
    http://www.scielo.br/pdf/ibju/v29n6/v29n6a02.pdf
    Also see this Feb 2008 study [PMID: 18267330] which compared open surgery to a group which had either laproscopic or robotic surgery (they combined the two groups due to similarity in surgical procedure).

  2. Cosmetic advantage due to smaller set of incisions vs. one large incision.

  3. Catheter may stay in for a shorter period of time.
    http://www.webmd.com/content/article/45/1688_50838.htm

  4. Less likely to need prescription pain killers.
    http://www.webmd.com/content/article/45/1688_50838.htm

  5. Reduced hospital stay.

  6. Recovery is faster due to above 5 points:
    http://www.webmd.com/content/article/45/1688_50838.htm

  7. Surgeon has better visualization of area due to lack of interference
    from blood and greater magnification. In laparascopic surgery the cavity
    is kept under pressure using a gas which improves the visual field.)
    http://www.ucihs.uci.edu/urology/Robot.html

  8. Although laparascopic surgery has historically used thermal dissection methods, newer athermal methods provide an advantage over the thermal methods in recovery of erectile dysfunction. [PMID: 17285018]

  9. Good results were obtained after following 1,000 patients in Paris [News] [PMID: 12629339] and additional studies referenced in Levinson, 2007 [PMID: 17285018] and Rassweiler et al, 2006 mostly showed margin rates as good or better than open surgery. Touijer & Guillonneau, 2006 feel that more data is needed publishing more in October 2007 in [PMID: 17188801]. The latter concluded that at the Memorial Sloan Kettering Institute "laparoscopic and retropubic radical prostatectomy provide comparable PSM rates for patients with clinically localized prostate cancer. The PSM rate over the study period remained unchanged in the RRP experience, indicating a mature and well-established operative technique, while that of LRP underwent a significant decrease, demonstrating that the procedure and therefore the results continued to evolve during the study." (A positive surgical margin, PSM, occurs when cancer cells are found at the region cut. This indicates that not all cancer cells were removed. RRP and LRP refer to open and laparascopic surgery respectively.)

  10. A survery reported in the Dec 1, 2007 issue of Urology Times indicated that "almost half" of all urologists in the survery were seeking additional training in the area of laparascopic or robotic surgery suggesting that urologists themselves view these approaches positively.


Disadvantages of laparascopic surgery have already been mentioned among the advantages of open surgery in Part 1. Positive surgical margins in the studies reviewed in Lepor, Rev Urol 2005;7(3):115-127 were worse for laparascopic surgery than open surgery.

Other Parts of this Series

RP vs. LRP vs. RLRP - Part 1. Open Surgery (RP)
RP vs. LRP vs. RLRP - Part 2. Laparascopic Surgery (LRP)
RP vs. LRP vs. RLRP - Part 3. Robotic Surgery (RLRP)
RP vs. LRP vs. RLRP - Part 4. What Surgeons and Others Say

Other Surgery Posts

Choosing a Surgeon - Part 1. Considerations
Choosing a Surgeon - Part 2. Finding a Surgeon

Lymph Node Dissection

Inguinal Hernia and Prostatectomy

Seminal Vesicle Ablation

2 comments:

ak said...

The post is correct. Let me simply note that we've remodeled the site. It's still heavily focused on prostate cancer surgery. However, there is a new Blog section and an expanded In the News. That section's latest entry is a Podcast for the Prostate Net in which we review the merits and pitfalls of robotic prostate surgery and present questions patients should ask their doctors. Finally, and this is the grandest labor of love, there is a page devoted to Behind the Mask, an invited opinion series for the Miami Herald. My personal favorite if the first item, First Do No Harm, in which I trace the history of laparoscopic prostate surgery.

The Palpable Prostate said...

Thanks, I've updated the links so they should be correct now.